What we still don’t know about coronavirus in San Antonio

San Antonio Mayor Ron Nirenberg, left, and Bexar County Judge Nelson Wolff talk with reporters in May 2018. Nirenberg and Wolff started a daily briefing Friday to update the public on the coronavirus pandemic. One of the first things they announced was that all playground equipment and basketball courts at city and county parks are now off limits because of continued large gatherings in violation of the parallel city and county stay-at-home orders.

Photo: William Luther /San Antonio Express-News

Weeks into the coronavirus crisis, San Antonio officials still haven’t provided enough comprehensive information to the public to show just how serious the extent of the virus is here and how officials plan to handle a possible surge in patients.

Unlike other cities in Texas — and in the rest of the United States — San Antonians still don’t know:

How many COVID-19 patients are on potentially life-saving ventilators.

How many are showing symptoms.

Where and when each patient was infected.

How the region would respond if a surge of patients overwhelmed hospitals.

It wasn’t until Friday that officials started providing figures on how many people with the virus have been hospitalized, something other municipalities have been doing since their first cases weeks ago.

Turns out that of the 120 confirmed cases reported by Metro Health, 33 have been in the hospital, Mayor Ron Nirenberg said at a briefing Friday evening.

When pressed for the information previously, a city spokeswoman said the city didn’t track the data.

“This is a public health emergency,” said Joseph Larsen, a Texas-based First Amendment attorney. “And this information is vital for the people to be able to respond to this crisis appropriately.”

San Antonio officials have argued that releasing information — initially, they didn’t even want to give an age range or whether the patient was male or female — would violate federal and state law, even though many other cities and counties don’t agree.

The city points to a federal law called the Health Insurance Portability and Accountability Act, or HIPAA, that in part forbids public entities from releasing identifying information about individual patients.

First Amendment attorneys and media advocates have argued for years that government officials misuse the law and apply it to information not covered by the act.

City spokeswoman Laura Mayes cited a portion of the state’s Health and Safety Code that states “reports, records, and information relating to cases or suspected cases of diseases or health conditions are not public information.”

That statute applies to health authorities as well as state and local health departments, Larsen said — but not to the city.

“This is exactly the sort of bureaucratic indifference that should make every American as mad as possible,” Larsen said. “What are they thinking? What can they possibly be thinking?”

Here’s what San Antonio officials have agreed to release to date:

The total number of cases in Bexar County, grouped by how many patients contracted the virus while traveling; through close contact with someone who has the virus; through an unknown source; and by how many cases are under investigation.

The total cases, broken down by sex.

The number of confirmed cases by age group, not specific ages.

How many tests have been conducted by Metro Health and how many of those turned up positive, negative or inconclusive. That figure does not include testing from local private labs.

When someone with the virus dies, the city has released the person’s gender, the age range of that person and whether the person had any underlying health conditions.

So far, all five people who have died of complications from COVID-19 in Bexar County have been women between the ages of 40 and 89. Four had underlying health problems.

On Thursday, Metro Health Director Dawn Emerick showed City Council members a map with colored circles showing where in Bexar County cases have been found.

The map, which otherwise has not been made available to the public, indicated that cases are pretty evenly distributed across the county. But it didn’t show which ones were the result of community spread or travel.

Such a map, Emerick told council members, won’t be made available to the public until next week.

Bexar County Judge Nelson Wolff disputed whether the public needs to know in what part of town residents who get the virus live.

“You don’t know where you picked it up,” Wolff said at the Friday media briefing. “In all likelihood, you don’t know.”

Harris County tells their residents the age range of each individual patient, their gender, what quadrant of the county they live in, how they were exposed to the virus and whether they’ve recovered.

So far, no patient in Bexar County has recovered from the disease, according to information released by the city of San Antonio.

Lubbock releases facts similar to the ones Harris County does — even though they only have about a fifth of the cases San Antonio has.

Changes in federal testing protocols have made it difficult to provide more detailed information to the public, Nirenberg said.

The lack of data from private testing facilities also has hampered those efforts, he said. As part of an emergency order Nirenberg issued last week, private labs conducting COVID-19 tests now must turn over positive and negative results to the city. Those figures are necessary for officials to pinpoint the local infection rate.

But those labs hadn’t complied with the order until this week, Nirenberg said.

“As we go through the next week, as we get more data and the testing process has been solidified, you’re going to see a lot more granular and detailed information about the testing results,” Nirenberg said.

San Antonio doesn’t track information about how many patients have been hooked up to ventilators, Mayes said in an email.

The city has tried to obtain that information from the Southwest Texas Regional Advisory Council, which manages emergency services for Bexar and surrounding counties.

The council also would help coordinate the response to patients surges, where hospitals' capacities are exceeded.

STRAC's executive director, Eric Epley, has not responded to requests for that information.

Providing more details about how many patients have been hospitalized could prompt more people here to take the virus seriously, said Cherise Rohr-Allegrini, a local public health consultant specializing in epidemiology.